=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386227023
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHANDLER ANN MARIE HUTCHESON BSW, RBT, QMHP-T
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/30/2021
-----------------------------------------------------
Last Update Date | 04/30/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 780 LYNNHAVEN PKWY STE 370
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23452-7353
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-480-0810
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 780 LYNNHAVEN PKWY STE 370
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23452-7353
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-480-0810
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number | RBT-21-165094
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------